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U1/zJ/z01a WED 15: ON FAX 209921$5960 Cannon C9075 _ ®001/001 <br /> EHD LOG NUMBER^EC�EIVEV <br /> SAN JOAQUIN COUNTY <br /> JUL 2 3 2014 ENVIRONMENTAL HEALTH DEPAPTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468,3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PcPa AIT/SERVICES l'P-UBLIC RECORDS RELEASE APPLICATION69 <br /> F <br /> APPLICANT:D 0On MJt ,MQ,�D6YINA 14YPBUSINESS/AGENCY: ao <br /> Gg ' <br /> ADDRESS: IOD` • Gyl•}(ar Cil• CITY/STATE/ZIP: MAV1{UA I GA!95sb Io <br /> PHONE(1): 14`0 11,# PHONE(2): 1451p -gD I D FACSIMILE: �?_S D <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> ,----,,//Staff will contact you to arrange an appointment date and time to review the requested records. <br /> [?"CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT I �(f L'vaE �z. �G vY" ;�2�Li r -J f DATE ;✓x:;_/- /�r <br /> r—r <br /> Electronic Information: Llst❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Stroet# street Name city ' Unit <br /> 1 <br /> aaK, r t., c6 r) ' I NO <br /> 2- Unit2 <br /> 3. <br /> 4. ` a3gi .✓J.. Mwntecn p <br /> " oz) Na �i units <br /> 6. <br /> 6. <br /> unit a <br /> 7. <br /> a• ❑Unit 3 <br /> 9. <br /> 10, <br /> Unlle <br /> Specific Date Range of Information Requested: From to <br /> ,.,/ - ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Ly UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ,SOLID WASTE FACILITryNEHI LEI ;J "s <br /> []'OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE - Ji1P�5' L,1 <br /> [UNDERGROUND TANK(MONITORINGIREMOVAL)V ❑FOOD FACILITY E]DAIRY .7-Zq-19 I <br /> WBOVEGROUND TANK,/, C3CHICKEN RANCHI Doe KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WAS'TEIRAZARDOUS MATERIAL ❑MOTELIHOTEL ❑PUMPERTRUCK/YARDICHEMICALTOILET6 <br /> ❑TIERED PERMITTED FACILITY ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑TATTealBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 6:00 AM-6:OOPM(EXCLUDING HOLIDAY$) <br /> 1. List un to ten addressaa in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one rile type MUST be selected. Fax to(208)464-0138 or mall to thea dress Indicated above. Address. <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. , <br /> 2. For assistance In Identifying the nature and content of EHD records,please contact FHP at the number noted above. <br /> 3. The EHD will notify the applicant If any EHD.filVs axlst. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. - <br /> A. Any file not returned In the same condition as released will be reorganized by END staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$126 depoelt prior to review. "'BOXED AREA-EHD USE ONLY_"^ <br /> 7 z4-I Lif <br /> 2 4fi'6! zC ,4,to Gca A4 15 6(o <br /> n GOm n(Sto la �� /11 t o <br /> Slo(G >`(7-1,1N /uc V) 4�� r s t j- e- 1-0-3 U 2� <br /> rh <br /> la Re affPPB�nlnptate ata maw 60 LC) g;?j 6 L,-,61 x -1 Z((�Q <br /> EHU Mot 4120114 <br /> Received Time Jul. 23. 2014 3: 06PM No. 6670 <br />